Healthcare Provider Details

I. General information

NPI: 1417171489
Provider Name (Legal Business Name): AARYA CHIROPRACTIC L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 JOHN F KENNEDY BLVD 1
JERSEY CITY NJ
07307-4126
US

IV. Provider business mailing address

3523 JOHN F KENNEDY BLVD 1
JERSEY CITY NJ
07307-4126
US

V. Phone/Fax

Practice location:
  • Phone: 201-217-1224
  • Fax:
Mailing address:
  • Phone: 201-217-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberMC005875
License Number StateNJ

VIII. Authorized Official

Name: DR. PRABHAKAR RAM
Title or Position: OWNER
Credential: D.C.
Phone: 201-217-1224